Washington Highlights: October
15, 2004
Congress Adjourns
for Election; Leaves Spending Bills in Limbo
Contents
Prior Issues
|
Congress has adjourned until after the election, putting off final
decisions on domestic spending for FY 2005 until at least mid-November
when the House and Senate return to Washington for a lame duck session.
Prior to adjourning, Congress completed action on only four of the
13 regular appropriations bills. The chairmen of both the House
and Senate Appropriations Committees have been predicting for months
that the combination of tight spending limits and a congressional
schedule compressed by primaries and the conventions would make
it difficult to pass any spending bill other than those covering
essential defense and homeland security efforts before the election.
As a result, non-defense federal programs are currently operating
under a continuing resolution (CR) that provides funding at FY 2004
levels through Nov. 20 [see Washington
Highlights, Oct. 1].
The remaining appropriations bills are expected to top the congressional
agenda for the lame-duck session scheduled for Nov. 16; however,
legislators may struggle to complete action on the bills, as lame
duck sessions are often non-productive in the absence of a compelling
deadline. In addition, House and Senate leaders disagree vigorously
about the various accounting maneuvers employed by the Senate Appropriations
Committee to provide additional funds for the two major bills of
interest to academic medicine: Labor-HHS-Education and VA-HUD-Independent
Agencies.
Information:
Dave Moore, Senior Associate Vice President
AAMC Government Relations
dbmoore@aamc.org
(202) 828-0525
New GAO Report Analyzes Proposed Changes to Medicare
Physician Payment Formula
The Government Accountability Office (GAO) Oct. 8 issued a report
that concludes that any of the recently proposed changes to the
Sustainable Growth Rate (SGR) system used to calculate Medicare
physician payments "could be implemented in a way that would
likely generate positive fee updates." The report, entitled
"Medicare Physician Payments: Concerns About Spending Target
System Prompt Interest in Considering Reforms" (GAO-05-85),
was required under the Medicare Modernization Act (MMA) and delivered
to the House and Senate Committees that oversee the Medicare program,
also advises that any change to the SGR system "will be very
expensive" and would increase Medicare spending on physician
services from 4 to 23 percent during CY 2005 - CY 2012, depending
on the type of change. Subsequently, the GAO warns that the implementation
of any changes, "may hinge on whether primary importance should
be given to stable fee increases of…fiscal discipline within
the Medicare program."
Requested amid Congressional concerns that projected Medicare
fee reductions for 2006 - 2012 will discourage physician participation
and reduce beneficiary access to care, the GAO report analyzes the
potential impact of specific changes to the SGR methodology. The
report also details how the SGR methodology has helped "substantially"
slow spending growth on physician services since its implementation
in 1998.
Working in collaboration with the Centers for Medicare and Medicaid
Services (CMS) Office of the Actuary (OACT), GAO estimates that
eliminating the use of the SGR spending target and basing physician
updates on annual increases in the cost of care (as proposed by
the Medicare Payment Advisory Commission) would, from CY 2005 through
CY 2014, "result in cumulative expenditures that are 22 percent
greater than projected under current law." According to GAO,
this would increase Medicare spending on Part B services from $16.9
trillion under current law to $19.1 trillion over the next 75 years.
In total, the GAO report analyzes six alternatives, including two
scenarios that combine two or more options.
Information:
Christiane Mitchell, Senior Legislative Affairs Manager
AAMC Government Relations
cmitchell@aamc.org
(202) 828-0526
Clinical Trials Database Proposed
Legislation to establish a database for all clinical trials and
their results was introduced Oct. 7 in both the House and Senate.
The Fair Access to Clinical Trials (FACT) Act (S. 2933/H.R. 5252)
would apply to clinical trials for drugs, biological products and
medical devices, and would require researchers to report all results
as well as information for patients seeking to enroll in studies.
Cosponsored by Senators Chris Dodd (D-Conn.), Edward Kennedy (D-Mass.),
Tim Johnson (D-S.D.) and Ron Wyden (D-Ore.), and Representatives
Edward Markey (D-Mass.) and Henry Waxman (D-Calif.), the FACT Act
would create an electronic clinical trials registry to provide physicians,
the general public, and patients seeking to enroll in clinical trials
access to basic information about those trials. The FACT Act would
require reporting of such details as research outcomes, basic demographic
information on subjects, sources of funding for the trial, significant
adverse events, and the product's FDA approval status.
The legislation would expand clinicaltrials.gov, a Web site established
in 1997 and run by the National Library of Medicine at the National
Institutes of Health, to include all clinical trials (except for
preliminary safety trials) and also would require submission of
all results, both positive and negative. In addition, the bill would
continue clinicaltrials.gov as a resource for patients seeking to
enroll in trials.
The proposal gives the Secretary of Health and Human Services oversight
of the registry to determine whether required information has been
submitted and whether submitted data are accurate. The bill mandates
participation in the registry as a prerequisite for Institutional
Review Board (IRB) approval. The bill also establishes strong enforcement
mechanisms, including monetary penalties of up to $10,000 per day
for manufacturers who refuse to comply.
Information:
Dave Moore, Senior Associate Vice President
AAMC Government Relations
dbmoore@aamc.org
(202) 828-0525
|
